Remote-Ready Senior Medical Claims & AR Analyst

Pioneers Medical Center; Meeker (CO); Remote; USD 65,000 - 90,000; Full time

Job summary

Pioneers Medical Center in Meeker, CO is seeking a Senior Medical Claims & Accounts Receivable Analyst to join our Revenue Cycle team. This role onsite or remote, reports to the Revenue Cycle Director, and will manage AR, analyze denials, and improve cash flow through accurate billing and proactive payer communications.

The ideal candidate has advanced knowledge of medical coding, billing, and payer requirements, with certification preferred.

Qualifications

• Advanced experience in medical claims, billing, accounts receivable, or revenue cycle management.
• Strong understanding of the healthcare reimbursement and claims process.
• Demonstrated experience researching and resolving complex medical claim denials and payment issues.
• Strong knowledge of insurance payer processes and requirements.
• Excellent analytical, organizational, and problem-solving skills.
• Ability to manage a high-volume AR workload while maintaining accuracy and thorough documentation.
• Strong written and verbal communication skills.
• Ability to independently research problems and follow issues through to resolution.
• Proficiency with electronic medical records (EMR), practice management, billing, claims, and payer systems.

Responsibilities

• Manage and actively monitor assigned AR to ensure timely and accurate reimbursement.
• Analyze aging reports and prioritize accounts based on dollar value, age, payer, denial reason, and likelihood of recovery.
• Develop and execute effective strategies to reduce outstanding AR and prevent accounts from becoming significantly aged.
• Identify trends in unpaid, underpaid, and delayed claims.
• Maintain accurate documentation of collection activities, claim status, follow-up efforts, and payer communications.
• Escalate high-dollar, complex, or unresolved accounts appropriately.
• Conduct detailed reviews of rejected, denied, and underpaid medical claims to determine the root cause of nonpayment.
• Research payer policies, contracts, medical necessity requirements, coding guidelines, authorization requirements, and claim submission rules.
• Prepare and submit corrected claims, reconsiderations, appeals, and supporting documentation as appropriate.
• Follow claims through the resolution process and ensure appropriate payment is received.
• Identify recurring denial patterns and recommend corrective action to prevent future denials.
• Investigate ongoing payment discrepancies, including underpayments, incorrect contractual adjustments, partial payments, and unexplained nonpayment.
• Compare payer payments against expected reimbursement and contractual terms.
• Identify systematic payer or internal billing issues that may be negatively affecting revenue.
• Work with billing, coding, clinical, administrative, and payer teams to resolve complex reimbursement problems.
• Escalate persistent payer issues when appropriate and maintain detailed records of resolution efforts.
• Apply knowledge of ICD-10-CM, CPT, HCPCS, modifiers, NCCI edits, payer-specific requirements, and general coding/billing principles when analyzing claims.
• Review claims for potential coding or billing errors contributing to denials or payment delays.
• Collaborate with certified coders, billers, providers, and other revenue cycle personnel when additional expertise or documentation is required.
• Identify opportunities to improve claim accuracy and first-pass payment rates.

Skills

Medical claims

Accounts receivable

Revenue cycle

Analytical skills

HIPAA compliance

Education

Medical coding certification

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Certified Professional Biller (CPB)

Tools

EMR systems

Practice management software

Billing software

Job description

Pioneers Medical Center in Meeker, CO is seeking a Senior Medical Claims & Accounts Receivable Analyst to join our Revenue Cycle team. This role onsite or remote, reports to the Revenue Cycle Director, and will manage AR, analyze denials, and improve cash flow through accurate billing and proactive payer communications.

The ideal candidate has advanced knowledge of medical coding, billing, and payer requirements, with certification preferred.